SEC Form 5
FORM 5 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||
Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol HCA Healthcare, Inc. [ HCA ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year) 12/31/2017 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Stock, par value $0.01 per share | 05/22/2017 | G | 9,366.66 | A | $0.00 | 1,088,856.0364 | I | Held indirectly through Hercules Holding II by Thomas F. Frist III 2017 Annuity Trust I(1)(2) | |||||||
Common Stock, par value $0.01 per share | 2,112(3) | D | |||||||||||||
Common Stock, par value $0.01 per share | 9,496.54 | I | Held indirectly through Hercules Holding II by Spouse(1)(4) | ||||||||||||
Common Stock, par value $0.01 per share | 802,176.7155 | I | Held indirectly through Hercules Holding II by Thomas F. Frist III 2007 Family Trust(1)(5) | ||||||||||||
Common Stock, par value $0.01 per share | 445,402.2284 | I | Held indirectly through Hercules Holding II by Thomas F. Frist III 2016 Annuity Trust II(1)(6) | ||||||||||||
Common Stock, par value $0.01 per share | 117,895.9175 | I | Held indirectly through Hercules Holding II by Thomas F. Frist III 2016 Annuity Trust IV(1)(6) | ||||||||||||
Common Stock, par value $0.01 per share | 43,824.5688 | I | Held indirectly through Hercules Holding II by Thomas F. Frist III 2015 Annuity Trust III(1)(6) | ||||||||||||
Common Stock, par value $0.01 per share | 2,079,808.4777 | I | Held indirectly through Hercules Holding II by Thomas F. Frist III 2017 Annuity Trust II(1)(6) | ||||||||||||
Common Stock, par value $0.01 per share | 28,489.62 | I | Held indirectly through Hercules Holding II by Trusts for Children(1)(7) | ||||||||||||
Common Stock, par value $0.01 per share | 2,348,330.3574 | I | Held indirectly through Hercules Holding II by Trusts for Children(1)(7) | ||||||||||||
Common Stock, par value $0.01 per share | 36,629,163.8593 | I | Held indirectly through Hercules Holding by Frisco, Inc.(1)(8) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. Hercules Holding II ("Hercules") holds 68,912,077 shares of the common stock of HCA Healthcare, Inc. Hercules is held by a private investor group, including affiliates of HCA Inc. founder Dr. Thomas F. Frist Jr. The Reporting Person may be deemed to be a member of a group exercising voting and investment control over the shares of common stock of HCA Healthcare, Inc. held by Hercules. However, the Reporting Person disclaims membership in any such group and disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein. |
2. The Reporting Person received a gift of 9,366.66 units of Hercules on May 22, 2017, which were subsequently transferred to The Thomas F. Frist III 2017 Annuity Trust I, of which he serves as trustee. Following receipt of this gift, the Reporting Person may be deemed the beneficial owner of the units of Hercules held by this trust and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Healthcare, Inc. |
3. Consists of common stock underlying 2,112 restricted share units granted to the Reporting Person on May 3, 2017 which shall vest on the sooner of the date of the 2018 annual shareholders' meeting of HCA Healthcare, Inc. or the first anniversary of the grant date. Vested shares will be delivered to the Reporting Person on the date the Reporting Person ceases to be a member of the Board of Directors of HCA Healthcare, Inc. |
4. The Reporting Person may be deemed to have an indirect beneficial ownership in respect of 9,496.54 units of Hercules through an indirect pecuniary interest in such units held by his spouse, and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Healthcare, Inc. |
5. The Reporting Person's spouse is trustee of The Thomas F. Frist III 2007 Family Trust, and the Reporting Person may be deemed to be the beneficial owner of the units of Hercules held by such trust and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Healthcare, Inc. |
6. The Reporting Person is trustee of (i) Thomas F. Frist III 2016 Annuity Trust II, (ii) Thomas F. Frist III 2017 Annuity Trust II, (iii) Thomas F. Frist III 2016 Annuity Trust IV and (iv) Thomas F. Frist III 2015 Annuity Trust III and may be deemed to be the beneficial owner of the units of Hercules held by these trusts and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Healthcare, Inc. |
7. The Reporting Person may be deemed to be the beneficial owner of the aggregate (i) 28,489.62 units of Hercules held by certain trusts for the benefit of the Reporting Person's children, each of which his sister serves as trustee, and (ii) 2,348,330.3574 units of Hercules held by certain trusts for the benefit of the Reporting Person's children, each of which his spouse serves as trustee, and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Healthcare, Inc. |
8. The Reporting Person may be deemed to share voting and dispositive power with respect to 36,629,163.8593 shares of HCA Healthcare, Inc. beneficially owned by Frisco, Inc. by virtue of his position as a director of Frisco, Inc. Frisco, Inc. has beneficial ownership of 36,629,163.8593 units of Hercules and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Healthcare, Inc. |
Remarks: |
/s/ Natalie Harrison Cline, Attorney-in-Fact | 02/14/2018 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |